Journal of Rehabilitation Medicine 51-11 | Page 51

Polio and post-polio syndrome in non-Western immigrants to Norway
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Table V. Psycho-social characteristics of subjects with late effects of polio
Non-western immigrant Western immigrant Native Norwegian
p-value
polio group (n  = 34)
polio group (n  = 32) polio group (n  = 1,342) χ 2
Unsatisfactory psychological health (n  = 30/31/1,247), %
40.0
Psychological problems in need of professional help (n  = 30/32/1,219), % 30.0
RSA total a (n  = 30/996), mean (SD)
Factor 1 A: Perception of self (6 items)
Factor 1 B: Perception of future (4 items)
Factor 2: Social competence (6 items)
Factor 3: Family cohesion (6 items)
Factor 4: Social resources (7 items)
Factor 5: Structured style (4 items)
Social support
Number of close friends (n  = 31/29/1,202), mean (SD)
Feeling lonely sometimes/often (n  = 31/31/1,260), %
3.9
3.7
3.1
3.9
3.9
4.0
3.6
19.4
29.0
(0.6)
(0.9)
(1.2)
(0.9)
(0.8)
(0.9)
(0.7)
4.4 (4.5)
74.2
3.8
3.6
2.9
3.8
4.1
4.4
3.3
11.1
16.8
(0.5)
(0.9)
(1.1)
(0.9)
(0.8)
(0.5)
(0.9)
7.8 (3.5)
54.8
3.9
3.9
3.2
3.8
4.1
4.3
3.6
0.000
0.040
(0.5)
(0.8)
(1.0)
(0.8)
(0.7)
(0.7)
(0.7) 0.936
0.102
0.126
0.891
0.410
0.021
0.111
8.6 (7.3)
51.6 0.005
0.043
SD: standard deviation. Numbers of respondents (n) are given for each variable. RSA: Resilience Scale for Adults. *Some to considerable degree.
polio group. Sixty-nine percent of the non-Western
immigrant group exercised rarely or never, compared
with 50% of the 2 other groups (Table IV).
The 2 immigrant polio groups reported a higher
degree of unsatisfactory psychological well-being than
the Norwegian polio group, while the same proportion
in the 2 immigrant polio groups reported psychological
problems requiring medical help or supervision (Table
V). Non-Western immigrant men reported psycholo-
gical problems significantly more often than women
(44% vs 25%).
Resilience scores were similar in the immigrant and
native groups, except for social resources, where the
non-Western immigrant group had a lower score. The
non-Western polio group had half as many good friends
as the Western immigrant group and the Norwegian po-
lio group (4 vs 9), and 74% of the non-Western group
reported feeling lonely (Table V).
The non-Western immigrant group reported a similar
number of concomitant diseases as the Norwegian polio
group (1.6 vs 2.0), although they were much younger.
There were sex differences regarding most diseases,
especially for non-polio musculoskeletal disorders (data
not shown). In the non-Western polio group, twice as
many women as men reported osteoporosis (39% vs
22%), while heart disease was reported more frequently
among men than women (11% vs none).
DISCUSSION
This study shows several differences between non-
Western immigrants with polio to Norway and a native
Norwegian polio group, in addition to differences
between non-Western and Western immigrants with
polio. In general, the non-Western immigrant group
reported more severe problems than the Western im-
migrant and the native Norwegian polio groups. The
Western immigrant and the native Norwegian polio
groups were similar regarding most demographic and
physical health-related characteristics. However, both
immigrant groups were less satisfied with their mental
health than were the native Norwegian polio group.
The mean age of the non-Western polio group was
25 years younger than the Western immigrant and the
native Norwegian groups, and some of the findings
can probably be explained by this age difference. The
non-Western immigrant group also had earlier onset
of acute polio, 3 vs 6 years as mean age of onset. This
is in accordance with a Swedish study (11), and pos-
sibly reflects that continuous exposure to poliovirus
in developing countries with endemic polio results in
a lower age of contracting polio. Similarly, in Western
countries the age of acute polio increased as polio
developed from being endemic to epidemic (10).
Hospitalization in the acute phase was less common
in the non-Western polio group, as only one-third
had been hospitalized, in contrast to two-thirds of the
Western immigrant and native Norwegian groups. In
addition, one-third of the non-Western group did not
know if they had been hospitalized in the acute phase.
This probably reflects a suboptimal healthcare system
in many developing countries at the time, which was
less well developed than in Norway 2 generations
previously.
The non-Western polio group reported new muscular
weakness, loss of muscle size and volume and post-
polio syndrome 10–20 years earlier after the acute
onset compared with the Western immigrant and the
Norwegian polio groups, and at a mean age of 31 years.
We do not know whether this earlier debut is due to
younger age when contracting polio or to increased
attention in recent years regarding the late effects of
polio. The mean age for onset of new atrophy and paresis
in native Norwegian polio patients is approximately 50
years (15).
Compared with the general non-Western immigrant
population to Norway at the same age, osteoporosis,
osteoarthritis, arthritis, lung disease and diabetes
were reported more frequently in the polio groups. In
J Rehabil Med 51, 2019